GAO Releases Report on CMS Oversight of Nursing Home Quality

Karen Morris in Clinical & Quality

The message below was received from AHCA staff related to the latest GAO report on CMS oversight of Nursing Home quality. The link to the full report is included and we have attached the one page highlight summary:

Today, the Government Accountability Office (GAO) issued a report Nursing Home Quality: CMS Should Continue to Improve Data and Oversight. The report considered quality data collected through Standard Surveys, Complaint Investigations, Staffing Data, and Clinical Quality Measures. According to the report, “Complaints can be filed with state survey agencies by residents, families, ombudsmen, or others acting on a resident’s behalf. “Further, the report clarifies complaint data“…did not include facility reported incidents - incidents that nursing homes report to state survey agencies and that are also recorded in the Automated Survey Processing Environment Complaint/Incident Tracking System – in this analysis.”

GAO Findings:
Of the four data sets reviewed, GAO states“…consumer complaints suggest(s) that consumer’s concerns over quality have increased, while the other three data sets – deficiencies, staffing levels, and clinical quality measures – indicate potential improvement in nursing home quality. ”Specifically, consumer complaints reported per home increased by 21 percent from 2005 – 2014, suggesting a potential decrease in quality. During the same period, the number of serious deficiencies identified per home with an on-site survey (standard survey) decreased by 41 percent over the same period, indicating potential improvement.

GAO Recommendations:
GAO recommends the Administrator of CMS take the following two actions:

  1. Establish specific timeframes, including milestones to track progress, for the development and implementation of a standardized survey methodology across all states.
  2. Establish and implement a clear plan for ongoing auditing to ensure reliability of data self-reported by nursing homes, including payroll-based staffing and data used to calculate clinical quality measures.
  3. The Administrator of CMS should establish a process for monitoring modifications of essential oversight activities made at the CMS central office, CMS regional office, and state survey agency levels to better understand the effects on nursing home quality oversight.

CMS Response:
CMS concurs with all recommendations and identifies key activities and/or changes currently under consideration that will meet the intent of the GAO recommendations.


Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15